{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:44:22Z","timestamp":1777898662473,"version":"3.51.4"},"reference-count":27,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005217","name":"National Center for Injury Prevention and Control","doi-asserted-by":"publisher","award":["CDC-RFA-CE19-1904"],"award-info":[{"award-number":["CDC-RFA-CE19-1904"]}],"id":[{"id":"10.13039\/100005217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Increasing knowledge about the toxicology of drug overdose and substance misuse (DOSM) is important in improving our understanding of the epidemic. We describe the Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity, which started collecting data on emergency department (ED) visits attributable to DOSM in 2017, with a focus on the toxicology results of a subset of clinical encounters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From November 1, 2017, through January 30, 2020, we collected near\u2013real-time data on DOSM-related ED encounters. The Minnesota Department of Health Public Health Laboratory tested leftover clinical specimens (blood and\/or urine) for the presence of various substances for patients who died, were hospitalized, had an atypical clinical presentation, or were part of a local drug overdose cluster. Testing looked for &gt;250 drugs or their metabolites, including those commonly misused (eg, methamphetamine, cocaine), prescription medications, synthetic cannabinoids and cathinones, and opioids. We describe characteristics of the overall group and a subgroup of clinical encounters with toxicology results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Specimens submitted from 6 EDs during the study period represented 239 clinical encounters. Methamphetamine was the most frequently detected substance (67.4%) but was suspected in only 45.6% of encounters. At least 1 opioid was detected in 42.5% of encounters but suspected in only 29.7%. Testing also detected potential adulterants and additives (eg, fentanyl, fentanyl analogues, levamisole) and showed frequent patient exposure to substances not reported by patients or suspected by clinicians. Nearly half (44.4%) of clinical encounters had &gt;1 substance detected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ED surveillance for DOSM encounters, enhanced by toxicology testing, can provide local situational awareness on overdoses, prevent potential mischaracterization of the true drug overdose epidemic, and inform harm reduction and drug overdose prevention efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549211042834","type":"journal-article","created":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T16:23:32Z","timestamp":1635870212000},"page":"87S-95S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Biosurveillance of Drug Overdoses and Substance Misuse Treated in Selected Emergency Departments in Minnesota, 2017-2020"],"prefix":"10.1177","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-9090","authenticated-orcid":false,"given":"Terra","family":"Wiens","sequence":"first","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Bilden","sequence":"additional","affiliation":[{"name":"Essentia Health, Duluth, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Saravia","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Peterson","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Wogen","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaila","family":"Hanson","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roon","family":"Makhtal","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5037-7426","authenticated-orcid":false,"given":"Nate","family":"Wright","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Roesler","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Lynfield","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St. Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,11,2]]},"reference":[{"key":"bibr1-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1111\/add.14878"},{"key":"bibr2-00333549211042834","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6834a2"},{"issue":"4","key":"bibr3-00333549211042834","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/j.1742-6723.2008.01110.x","volume":"20","author":"West E.","year":"2008","journal-title":"Emerg Med Australas"},{"key":"bibr4-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1202561"},{"issue":"1","key":"bibr5-00333549211042834","first-page":"53","volume":"26","author":"Gurney SMR.","year":"2014","journal-title":"Forensic Sci Rev"},{"key":"bibr6-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1177\/0960327117698542"},{"issue":"12","key":"bibr7-00333549211042834","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1097\/01.EEM.0000440686.75528.a2","volume":"35","author":"Roberts JR","year":"2013","journal-title":"Emerg Med News"},{"key":"bibr8-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1177\/0033354919887741"},{"key":"bibr9-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1373\/49.3.357"},{"key":"bibr10-00333549211042834","unstructured":"Centers for Disease Control and Prevention. CDC\u2019s Laboratory Response Network for Chemical Threats. Accessed February 1, 2020. https:\/\/emergency.cdc.gov\/lrn\/chemical.asp"},{"key":"bibr11-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.2851"},{"key":"bibr12-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.18514"},{"key":"bibr13-00333549211042834","volume-title":"Nonfatal Hospital-Treated Drug Overdose Surveillance and Epidemiology (DOSE) Summary","author":"Coutinho S.","year":"2020"},{"key":"bibr14-00333549211042834","unstructured":"Minnesota Compass. Northland Region data. 2020. Accessed October 1, 2020. http:\/\/www.mncompass.org\/profiles\/region\/northland"},{"key":"bibr15-00333549211042834","unstructured":"DeLaquil M.\n                      Differences in Rates of Drug Overdose Deaths by Race\n                      . Minnesota Department of Health; 2020. Accessed October 7, 2020. https:\/\/www.health.state.mn.us\/communities\/opioids\/documents\/raceratedisparity2019prelimfinal.pdf"},{"key":"#cr-split#-bibr16-00333549211042834.1","unstructured":"US Drug Enforcement Administration. 2019 National Drug Threat Assessment. US Department of Justice, Drug Enforcement Administration"},{"key":"#cr-split#-bibr16-00333549211042834.2","unstructured":"December 2019. Accessed May 24, 2021. https:\/\/www.dea.gov\/documents\/2020\/2020-01\/2020-01-30\/2019-national-drug-threat-assessment"},{"key":"bibr17-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1002\/dta.220"},{"key":"bibr18-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.4306"},{"key":"bibr19-00333549211042834","volume-title":"Drug Early Warning From Re-Testing Biological Samples: Maryland Hospital Study","author":"Wish ED.","year":"2018"},{"key":"bibr20-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2010.03.004"},{"key":"bibr21-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.03.010"},{"key":"bibr22-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1111\/dar.12502"},{"key":"bibr23-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.07.017"},{"key":"bibr24-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1177\/0033354919857084"},{"key":"bibr25-00333549211042834","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610300"},{"issue":"4","key":"bibr26-00333549211042834","first-page":"149","volume":"7","author":"Sharma P.","year":"2012","journal-title":"Iran J Psychiatry"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549211042834","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00333549211042834","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549211042834","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:37:23Z","timestamp":1777628243000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00333549211042834"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11]]},"references-count":27,"journal-issue":{"issue":"1_suppl","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1177\/00333549211042834"],"URL":"https:\/\/doi.org\/10.1177\/00333549211042834","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11]]}}}